Public Hearing Presentation Retaining Value and Quality in a changing healthcare landscape Teddy Mosomothane 17 May 2016
Embracing the opportunity to contribute We appreciate the inquiry process as partly leading towards recommendations on: The average Bankmed member is currently Appropriate policy and regulatory mechanism that would better off financially by an amount of support the goal of achieving accessible, affordable, 34% of contributions innovative and quality private health care; versus if the member joined the average Role of competition policy and competition law in open medical scheme* achieving pro-competitive outcomes in health care. Bankmed intends to share some insights primarily from a closed medical scheme perspective in the banking industry. 2
Agenda 1. About Bankmed 2. Insights on risk pooling successes resulting in The average Bankmed member is currently better value better off financially by an amount of 3. Investment by employer groups in health and 34% of contributions wellness versus if the member joined the average 4. Targeted focus on quality of healthcare open medical scheme* 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change Bankmed’s recent change of administrator 7. 8. Conclusion 3
About Bankmed Collaboration among bankers, going back to 1914 Not-for-profit restricted medical scheme in the banking industry The average Bankmed member is currently Healthcare funding to more than 50 financial institutions better off financially by an amount of 107 553 principal members, 216 262 beneficiaries (31/12/2015) 34% of contributions Market share: versus if the member joined the average 2.55% of the total industry’s principal members open medical scheme* (and 2.31% of beneficiaries) 6.16% of the restricted medical schemes’ principal members (5.20% of beneficiaries) 4
Bankmed Vision & Mission Vision The average Bankmed member is currently To be the Medical Scheme of Choice for the Banking better off financially by an amount of 34% of contributions Industry versus if the member joined the average open medical scheme* Mission To be an affordable Medical Scheme that guarantees best-of-class member experience, value and quality 5
Strategic Overview Competitive Benefit Service Excellence Offering The average Bankmed member is currently better off financially by an amount of 34% of contributions Relevance in a Health & Wellness changing versus if the member joined the average environment open medical scheme* Integrated digital strategy Innovation / Research & Development Value to members 6
Value Network Analysis (limited to core deliverables) 7
Partnership Philosophy Collaborate optimally, extract as much The average Bankmed member is currently better off financially by an amount of value as possible from the partnership, 34% of contributions while maintaining the Scheme’s brand versus if the member joined the average open medical scheme* identity, and an appropriate level of autonomy 8
Bankmed Value Attributes What sets Bankmed apart 42,5% 33% AA + vs Better value The average Bankmed member is currently The average Bankmed member is currently 33,3% better off financially by an amount of better off financially by an amount of 34% of contributions 34% of contributions Compared to Global Credit Solvency Ratio (2015) an average Rating – 2015 vs Industry Average (2014) versus if the member joined the average versus if the member joined the average Open scheme (Highest in the Industry) open medical scheme* open medical scheme* 9% 6 A fair spread of vs industry Non-healthcare benefits providing average of Expense Ratio Benefit for low to high (Administration, Managed Options 11% Healthcare needs and Healthcare & General affordability Administration expenses) 9
Bankmed AA+ Credit Rating Bankmed retained an AA+ credit rating in 2015, the highest rating a medical scheme can attain. Rating assigned by Global Credit Ratings (GCR). The average Bankmed member is currently better off financially by an amount of Bankmed is one of only two South African medical schemes 34% of contributions with an AA+ credit rating. Attributes contributing to the AA+ rating according to GCR: versus if the member joined the average open medical scheme* Strong earnings capacity which is well managed Large and stable membership base with a favourable age profile High level of solvency and strong historical track record Large and diverse investment portfolio generating significant investment returns at reasonable risk levels 10
Agenda 1. Background about Bankmed 2. Insights on risk pooling successes resulting in better The average Bankmed member is currently value better off financially by an amount of 34% of contributions 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare versus if the member joined the average open medical scheme* 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change Bankmed’s recent change of administrator 7. 8. Conclusion 11
Bankmed benchmarking - 2016 • Benchmark against 128 options offered by 12 leading open membership medical schemes 12
Bankmed benchmarking - 2016 • Benchmark against 128 options offered by 12 leading open membership medical schemes 13
Bankmed benchmarking - 2016 • Benchmark Bankmed against 12 leading open membership medical schemes • Results as a percentage of Bankmed contributions: Cost Benefit Value PMB Plan -66% -44% 22% Basic Plan -13% 15% 28% Core Saver Plan -24% 1% 25% Traditional Plan -34% 3% 36% Comprehensive Plan -19% 19% 38% Plus Plan -26% 6% 32% -22% 11% 33% 14
Bankmed benchmarking - 2016 • Benchmarking exercise: – Bankmed members would (on average) be 33% worse off on an equivalent open membership medical scheme option – The calculations of relative value have been prepared by Willis Towers Watson using the Bankmed 2015 membership and claims profile – The value differential has increased each year from 2013 to 2016 • Reasons for the value differential: – The value differential of 33% can be only partly explained by the younger age profile of the Bankmed membership (12%) and the lower non healthcare costs (3%) – The unexplained value differential (18%) is due to the compulsory nature of the Bankmed membership 15
Protecting Our Future - and the Future of Our Members Employers Groups can The average Bankmed member is currently better off financially by an amount of protect the Bankmed risk pool 34% of contributions from the loss of younger / healthier members versus if the member joined the average to a large degree by retaining the condition open medical scheme* of employment that requires membership of Bankmed This will enable the Employer Groups to offer their employees access to affordable private healthcare on a sustainable basis in the future. 16
Agenda 1. Background about Bankmed 2. Insights on risk pooling successes resulting in better value The average Bankmed member is currently 3. Investment by employer groups in health and wellness better off financially by an amount of 34% of contributions 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change versus if the member joined the average open medical scheme* 6. An opportunity for collaboration and a phased response to necessary change Bankmed’s recent change of administrator 7. 8. Conclusion 17
Partnerships in Health The average Bankmed member is currently Aligned health and wellness strategies better off financially by an amount of 34% of contributions Sharing of information on the health of the organization versus if the member joined the average open medical scheme* Monitor performance of the health and wellness initiatives 18
Employer Group Client Reporting Demographic overview The average Bankmed member is currently Claims & Utilization better off financially by an amount of Clinical Review 34% of contributions versus if the member joined the average HIV/AIDS open medical scheme* Personal Health Assessment (PHA) and Individual Stress Assessment (ISA) 19
Membership by Gender (Jan – Dec 2014) 60,00% 57,04% 55,46% The average Bankmed member is currently 50,00% 44,54% better off financially by an amount of 42,96% 40,00% 34% of contributions Female versus if the member joined the average 30,00% Male open medical scheme* 20,00% 10,00% 0,00% Employer Client: X Bankmed 20
Membership by Age (Jan – Dec 2014) 33,10% 35,00% 32,06% 30,00% The average Bankmed member is currently 23,34% 25,00% 22,89% better off financially by an amount of 20,00% 17,56% 34% of contributions 17,34% 15,00% versus if the member joined the average 11,48% 11,32% 10,74% 10,68% 10,00% open medical scheme* 4,81% 4,57% 5,00% 0,06% 0,04% 0,00% 0 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 65 66+ Bankmed Employer Client: X 21
Recommend
More recommend
